title: Optimizing health and health care systems for children with special health care needs using the life course perspective.
abstract: To date, life course research in maternal and child health has largely focused on elucidating fetal and early life influences on adult health and less on promoting the health of children with special health care needs (CSHCN). Consideration of life course theory (LCT) for CSHCN is especially important given their increasing prevalence and comorbidity, their disproportionate vulnerability to weaknesses or instability in the health care system, and the growing evidence linking child and adult health and quality of life. In this commentary we seek to advance the consideration of LCT for CSHCN. We (1) briefly summarize key issues and the importance of a life course approach for CSHCN; (2) present illustrative findings from population-based cross-sectional data that serve to generate hypotheses that can be more rigorously examined when population-based longitudinal data become available; and (3) discuss the application of life course principles as a driving force in the continued implementation and improvement of integrated systems of care for CSHCN.
authors.affiliation: The Child and Adolescent Health Measurement Initiative, Oregon Health and Science University, Portland, OR, USA, bethellc@ohsu.edu.
authors.forename: Christina D
authors.initials: CD
authors.lastname: Bethell
authors.forename: Paul W
authors.initials: PW
authors.lastname: Newacheck
authors.forename: Amy
authors.initials: A
authors.lastname: Fine
authors.forename: Bonnie B
authors.initials: BB
authors.lastname: Strickland
authors.forename: Richard C
authors.initials: RC
authors.lastname: Antonelli
authors.forename: Cambria L
authors.initials: CL
authors.lastname: Wilhelm
authors.forename: Lynda E
authors.initials: LE
authors.lastname: Honberg
authors.forename: Nora
authors.initials: N
authors.lastname: Wells
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology* / Q000517:prevention & control; D015897:Comorbidity; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration* / Q000592:standards; D006306:Health Surveys; D006803:Human Development; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D015995:Prevalence; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D064890:Social Determinants of Health; D014481:United States / Q000453:epidemiology